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CA prepares for health care battle

The results of a presidential election won by Republican Donald Trump has some in a panic. And with GOP majorities in both houses of Congress, Trump presumably can do just about anything.

But California health advocates are not talking about abandoning the state’s healthcare system. They’re preparing for a fight.

“My advice to the public is they should enroll in coverage and fight like hell to keep it.” — Anthony Wright

“Now is a time when we stop whining and start messaging,” said labor organizer Alma Hernandez, the executive director of SEIU’s state council. “We have to tell the story of what losing your healthcare means,” she said at a December healthcare forum.

California was one of the first states to embrace the Affordable Care Act’s state health insurance marketplace, called Covered California. It also took the Medicaid expansion, adding over 3.6 million Californians to the state’s low-income health insurance program, Medi-Cal.

According to Health Access California, which advocates for the expansion of health care services, at least 90 percent of Californians who buy health care coverage through Covered California receive financial assistance. Congress is expected to cut some of those subsidies in a budget reconciliation bill next year.

Larry Levitt, from the Kaiser Family Foundation, said about 3 million Californians are still uninsured. Nationally, 27 million Americans are uninsured.

“Amazing enough,” Levitt said at last month’s Covered California Board meeting, “the public does not actually understand this – most of the public does not realize that the uninsured rate is in fact at its lowest rate ever due to the ACA. And unwinding a law that provides benefits on this scale would in fact be unprecedented.”

According to the Kaiser Family Foundation, the rate of uninsured has dropped by about 8 percent since 2011, and since 2014, the California’s growth in premiums is 12.9 percent compared to the national average of 33.2 percent.

“So again, I think, California demonstrates that the model can work, it’s just not necessarily working everywhere – yet,” Levitt said.

Republicans in Congress are expected to repeal the ACA in early 2017 through a process called budget reconciliation.

Kaiser’s survey in 2015 found that 46 percent of uninsured adults said they tried to enroll in health insurance but it was too expensive. Other reasons for being uninsured were being undocumented or not knowing they would qualify for financial aid.

Diana Dooley, California’s Secretary of Health and Human Services, has acknowledged the ACA is not perfect. As chairwoman of the Covered California Board and as a speaker at Health Access California’s healthcare forum, Dooley repeated her willingness to improve the system when it comes under review by national Republicans.

“If there is an opening, if there is an opportunity to be in a conversation with other states, red and blue states together, I am of the opinion that we need to take that opening,” Dooley said at the forum. “And I feel obligated to try to get the best we can out of whatever is happening and to know as much as we can about what the real risk is.”

Republicans in Congress are expected to repeal the ACA in early 2017 through a process called budget reconciliation. The effective repeal date, however, might not be until three years later, giving legislators time to decide what to replace it with.

As health insurance premiums rise and the requirement to buy insurance is eliminated, people would drop their healthcare coverage.

“Listen, if it’s repealed nationally, without providing coverage for the 20 million people that currently have it, the Trump administration’s going to have a big problem on its hands,” former California Gov. Gray Davis said at a post-election forum on Nov. 10. “They can’t just repeal it. They’re going to have to put in something that’s going to accommodate those 20 million people – many of them in red states.”

And while repeal and replace is a strong possibility, advocates worry that repealing, even if its effective date is not until later, without a replacement would cause uncertainty and rates to rise. Not to mention, the Republicans plan to cut federal spending, which would include the Medicaid expansion and federal subsidies offered through Covered California.

“It would be catastrophic chaos to our health care system and ignite a political firestorm if they sought to repeal without any replacement in forth,” said Anthony Wright, executive director of Health Access California.

As health insurance premiums rise and the requirement to buy insurance is eliminated, people would drop their healthcare coverage. This would leave a smaller and sicker pool – an unsustainable formula for insurance companies.

Both plans by President-elect Trump and House Speaker Paul Ryan, R-Wisconsin, would permit consumers to buy insurance across state lines and make health insurance premiums tax deductible.

The plans also include block-granting Medicaid and promoting consumer use of Health Savings Accounts, a tax-exempt trust used by those with high deductible health plans.

Ryan’s reform to block grant Medicaid would eliminate the federal government matching funds for every dollar California puts into its Medicaid program. This November, California voters approved three measures, Proposition 52, 55, and 56, that would increase the state’s funding to Medi-Cal.

While some say allowing health insurance to be bought across state lines promotes competition, healthcare advocates in California worry that it might lower standards as insurers would flock to a state with less regulation and be able to take that minimal coverage to California – not adhering to the rules California mandated.

Trump’s plan, according his campaign website, is similar to Ryan’s, but Trump has three additional points.

“We must make sure that no one slips through the cracks simply because they cannot afford insurance,” it says on Trump’s website. He proposes reviewing basic options for Medicaid so “those who want healthcare coverage can have it.”

Ryan’s plan prohibits insurers from denying a person based on their health or age, but does not mention what could be done if a person cannot afford insurance.

Trump also proposes requiring healthcare providers, such as doctors, clinics, and hospitals, to be transparent with their prices so people can “shop to find the best prices for procedures, exams or any other medical-related procedures.”

Trump’s other proposal is to remove barriers for foreign drug providers that “offer safe, reliable and cheaper products” and would allow consumers access to “imported, safe and dependable drugs from overseas.”

“There’s a huge threat looming,” Wright said, “but because the impact would be so severe, there’s also reason to believe that there would be some elected officials who will hopefully pull back from these proposals.”

“People should not worry about their coverage being taken away this year or next year,” Wright said. “My advice to the public is they should enroll in coverage and fight like hell to keep it.”

Gibarian

With a full-scale repeal, California could always implement something on the level of MassCare. It would mean detangling many of the education funding mandates and scaling back Medi-Cal (which rewards poor family planning as it is). California taxes HSAs as it is, so a switch to greater use of HSAs at the same time as California is already implementing SecureChoice shows poor foresight. We just passed a huge income tax increase, and it would have been far more wise to hold that option in reserve (as well as SDI/PFL expansion) to patch up any healthcare funding mandates rather than throw money at an educational system where cultural rather than budgetary challenges are the problem.